Local Plans

How the plans work

Get access to a local network of doctors that take care of your overall health, with simple, fixed copays and a unique team-based approach to your care. These special plans are only available in certain locations.

Preventive care

You’ll get 100% coverage for preventive care when you use doctors in your network. Preventive care means things like annual checkups, vaccinations, mammograms and other screenings.

Simple copays

You’ll have simple copays so you can easily predict your costs. And with copays, there’s no need to meet your deductible first.
      $35 for primary care
      $75 for specialists
      $75 for urgent care
      $4 for video doctor visits

Other care

You’ll pay the full cost for any additional care until you meet your deductible. After that, the plan pays 75% of all in-network costs. However, the Centers of Excellence program provides 100% coverage for most serious medical procedures like spine surgery and heart surgery.

Easy, affordable prescriptions

All generic prescriptions are just $4.

Annual deductible

The Mercy Southwest Missouri Local Plan and the Banner Local Plan have a $3,000 annual deductible if you cover just yourself, and $6,000 if you cover dependents. All other Local Plans have a $1,750 annual deductible for individual coverage, and $3,500 if you cover dependents. 

Emergency room copay

In addition to your annual deductible, you will also have a $300 emergency room copay that will apply to out-of-pocket maximum. Once you’ve met your annual deductible, you will only pay the $300 copay until your out-of-pocket is met. 

Total out-of-pocket costs

The maximum amount you can spend out of pocket will be $6,850 for yourself or $13,700 for yourself and your dependents. Once you reach this maximum amount, all your visits and costs will be covered at 100%.

How the team-based approach works

Primary care physician
You’ll get a family doctor who is dedicated to keeping you healthy.
Top local doctors
You’ll get access to some of the best doctors in your area, but the coverage is limited to this network.
Dedicated team
You’ll get doctors that work together as a team to protect and improve your overall health.
No out-of-network
If you have a medical emergency, you can access care outside the network.

Please note: Here’s where these plans are currently available:

  • Banner Local Plan: Phoenix, Arizona area
  • Emory Local Plan: Atlanta, Georgia area
  • Memorial Hermann Local Plan: Houston, Texas area
  • Mercy Arkansas Local Plan: Northwest Arkansas and Fort Smith; McDonald County, Missouri
  • Mercy Oklahoma Local Plan: Oklahoma City, Ada, and Ardmore, Oklahoma
  • Mercy St. Louis Local Plan: in and around St. Louis, Missouri
  • Mercy Southwest Missouri Local Plan: Southwest Missouri, including Joplin and Springfield areas
  • Ochsner Local Plan: Baton Rouge, New Orleans, and Slidell, Louisiana areas
  • St. Luke's Local Plan: Boise, Idaho area
  • UnityPoint Local Plan: portions of Iowa, western Illinois, and Peoria, Illinois areas

Other benefits

$4 doctor visits: Ever wish you could see a doctor without leaving your house? With Doctor On Demand™, you can video chat with a doctor 24/7 for just a $4 copay. Simply download the app or go online to speak with a board-certified physician, licensed psychologist or psychiatrist today. 

World-class care centers: For serious conditions, the Centers of Excellence program offers you and your family world-class care, often at zero cost. (limited to certain conditions).

Personal health assistance: Get expert second opinions and much more at no cost with Grand Rounds, just visit grandrounds.com/walmart

Important information

The Mercy Southwest Missouri Local Plan and Banner Local Plan will cost:

     $23.50 per paycheck for associates

     $131.00 per paycheck for associates plus their spouse/partner

     $38.70 per paycheck for associates plus their children

     $153.50 per paycheck for associates plus their family

All other Local Plans will cost:

     $47.60 per paycheck for associates

     $197.80 per paycheck for associates plus their spouse/partner

     $74.50 per paycheck for associates plus their children

     $233.90 per paycheck for associates plus their family

The Local Plans will cost more if you and/or your spouse/partner use tobacco products and choose not to enroll in and complete a Quit Tobacco program. The plan will also cost more for using doctors outside the network.

To check out all the rates for the Local Plans, including tobacco user rates, and all costs of all our plans, please see our rate sheet.

If you are enrolled in Medicare Part D, you are not eligible to enroll in any Walmart-sponsored medical plan.

2019 Accountable Care Plans (ACP)

The 2019 ACP options will be renamed the Local Plans for 2020. In addition to the names, there’s one key change to these plans:

  • In 2019, the Presbyterian ACP is available in the Albuquerque and Santa Fe NM area. In 2020 that plan will be discontinued.

Other than this change and your cost per paycheck, all the other information on this page applies to your current coverage.

For complete details about the 2019 plans, see the 2018 Associate Benefits Book with 2019 Summary of Material Modifications.